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General NPI Number Information
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NPI Number | 1033541370
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Entity Type | Individual
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Provider Name | JACQUELINE J CAMPBELL MS, RD, CDN, LDN
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Gender | Female
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 308 HAZARD AVE
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City | ENFIELD
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State | CT
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Zip | 06082-4613
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Country | US
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Telephone | 860-698-0656
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Fax | 860-929-0858
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Provider Business Mailing Address
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Address Line | 39 CONCORD TER
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City | SOMERS
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State | CT
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Zip | 06071-1907
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Country | US
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Telephone | 413-854-1277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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